PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENTOF DUMPING SYNDROME AND ITS RELATION TO BARIATRIC SURGERY

Quality of Life of Young Gastric Cancer Survivors: An Interpretation in the Context of Our Society

Background and Objectives: This retrospective case-control study aimed to investigate the quality of life (QoL) of young gastric cancer survivors and determine what should be pursued to obtain the best QoL for them after surgery. Materials and Methods: Patients with stage I gastric cancer who underwent distal subtotal gastrectomy were included. The European Organization for Research and Treatment of Cancer Quality of Life questionnaires were used to assess QoL. The QoL outcomes of younger (age 30-49 years, n = 76) and older (age 50-69 years, n = 232) groups were compared preoperatively, 3 months, and 1 year postoperatively. Results: There was no statistically significant difference in the preoperative QoL except for the physical functioning scale, which favored the younger group (p = 0.020). This difference remained significant throughout the postoperative periods (3 months, p = 0.002; 1 year, p = 0.004). Better QoL was found for the younger group according to the body image scale (p = 0.031). However, it was limited to the 3-month postoperative assessment. Persistent QoL disadvantages for the younger group were revealed by the diarrhea scale at the 3-month (p = 0.007) and 1-year (p = 0.005) postoperative assessments. Conclusions: While young gastric cancer survivors enjoyed better QoL in physical functioning and body image, worse QoL was related to diarrhea after surgery. Despite ever-rising concerns about QoL deterioration in elderly patients in our aged society, young gastric cancer survivors also need QoL support.

Prevalence of Dumping Syndrome and Its Determinants Among Post-Bariatric Surgery Adult Patients at King Fahad General Hospital, Jeddah, 2019-2020

Background Bariatric surgery is one of the most effective interventions for morbid obesity. Despite its benefits, unwanted consequences such as dumping syndrome (DS) have been reported following the procedure. This study aims to estimate the prevalence of DS and identify the factors associated with it in Saudi Arabia. Methodology This cross-sectional study collected data from patients who underwent bariatric surgery at King Fahad General Hospital, Jeddah, Saudi Arabia, in 2019-2020. A validated questionnaire was used to collect the data. The questionnaire included demographic items such as age and sex and items relating to DS such as nausea, vomiting, and palpitations. A modified version of the Sigstad diagnostic scoring system was used to confirm the diagnosis. Results Of the 240 investigated cases, two-thirds (67.5%) were females. The most reported symptoms were nausea (37.9%), vomiting (36.7%), desire to lie down (25.5%), restlessness (25.5%), and abdominal fullness (23.7%). Based on the modified Sigstad diagnostic scoring system, 75 (31.4%) patients met the criteria for DS. The bivariate analysis showed the prevalence was significantly higher in females (36.4%), those with university qualifications (40.3%), and those with high monthly income (62.5%) (p<0.05). Also, dietary behaviors in terms of frequency, size of meals, and drinking liquids with meals were significantly associated with the prevalence of DS, where the lowest prevalence was recorded among those who ate more than one small meal (10.9%), while the highest prevalence was found in those who ate more than one large meal (81.8%); also, the prevalence was significantly higher in patients who drank liquids with meals (40.8%) than those who drank liquids between meals (26.8%) (p<0.05). Conclusion In this single institutional study, we report a 31.4% prevalence of DS among our cohort. The predictors of the syndrome include gender, education level, monthly income, eating more than one large meal per day, and drinking liquids with meals. In the future, these predictors will be explained to patients before and after bariatric surgery to reduce the prevalence of such inconvenient syndromes.

Estado nutricional e clínico de pacientes submetidos à cirurgia bariátrica

Objetivo: analisar o estado clínico e nutricional de pacientes submetidos à cirurgia bariátrica. Métodos: trata-se de um estudo epidemiológico observacional, com delineamento transversal, norteado pela ferramenta STROBE. Foi realizado entre 2015 e 2016, com dados de pacientes submetidos à cirurgia bariátrica em Y de Roux nos anos de 2012 a 2014, em um hospital privado de Minas Gerais. A coleta de dados ocorreu por meio de questionário semi-estruturado, elaborado pelos pesquisadores. Para verificar a existência da associação entre as variáveis do estado nutricional e clínico com o tempo pós-cirúrgico, utilizou-se o teste Qui-quadrado de Pearson ou Exato de Fisher para as variáveis categóricas e, para as contínuas, os testes Kruskal-Wallis ou Mann-Whitney. Resultados: verificou-se significância estatística para as variáveis: “enfraquecimento de unhas” (p=0,002), “êmese” (p=0,018), “frequência de consumo alcoólico” (p=0,018) e “número de refeições diárias” (p=0,028) no grupo feminino. Conclusão: este estudo evidenciou alterações no componente clínico e nutricional das pacientes submetidos à cirurgia bariátrica. Observou-se associações estatisticamente significativas no grupo feminino, incluindo mudanças no perfil clínico de maior episódio de êmese e maior frequência no consumo de álcool. Em relação ao perfil nutricional, pacientes do sexo feminino apresentaram maiores proporções no número de refeições e maior enfraquecimento nas unhas após o procedimento cirúrgico. Reforça-se a importância do acompanhamento e orientação nutricional e psicológica contínuas, pré e pós cirúrgicas, minimizando os impactos negativos deste resultado na saúde dos indivíduos.

An Alternative Method for Treating Dumping Syndrome Using Hemoclips

Surgeries for obesity can lead to complications. Dumping syndrome is one such complication caused by the quick passage of hyperosmolar chyme from the stomach to the duodenum. Mild cases can be cured with dietary modification and medical treatment. However, refractory cases may need invasive treatment options, such as transoral outlet reduction or surgery. We successfully treated a 48-year-old female with dumping syndrome, using a combination of argon plasma coagulation and hemoclips to narrow the pyloric lumen. We suggest that this new technique could be a cheap and easily accessible alternative to surgery, especially in countries where the specialised devices needed to treat such cases are unavailable.

Protein Intake, Adherence to Vitamin-Mineral Supplementation, and Dumping Syndrome in Patients Undergoing One Anastomosis Gastric Bypass

INTRODUCTION

One anastomosis gastric bypass (OAGB) is an effective bariatric procedure. However, nutritional deficiencies or dumping syndrome (DS) may occur. The aim of this study was to assess adherence to nutritional recommendations and development of DS in a 3-year OAGB patient follow-up.

METHODS

For 150 OAGB patients, in our center, data were collected through the electronic platform and by an individual telephone interview. The inclusion criterion is OAGB as a primary bariatric procedure, no revisional surgery, or no pregnancy. The adequacy of daily protein intake cutoff was defined as 60 g. Adherence to micronutrient supplementation protocol was considered if a minimum of 5 takes/week were reported. To evaluate the occurrence of DS, the Sigstad score questionnaire was used. For statistical analysis, a significance level less than 5% (p < 0.05) was considered.

RESULTS

A total of 150 patients (80% females), BMI 44.3 ± 21.3 kg/m², were subjected to the OAGB procedure. Of those, 128 fulfilled the study inclusion criteria. After 3 years, the mean %EBMIL was 78.4 ± 14.4. During the 3-year follow-up, the average protein intake was 60 g/day, and 48% reported an adequate daily protein intake. Adherence to the micronutrient supplementation protocol was reported by 70%. According to the Sigstad score questionnaire, DS was present in 24% of patients.

CONCLUSION

A significant part of OAGB patients does not comply with the nutrition prescription assessed, emphasizing the need to improve team/patient communication strategies. Long-term studies are needed to characterize and assess the health impact of protein, vitamin, and mineral malnutrition in patients undergoing OAGB.

Evaluation of depression and anxiety symptoms, alcohol consumption, and binge eating in older adults undergoing bariatric surgery: a 6-year follow-up

INTRODUCTION: The literature remains scarce on the late effects of bariatric surgery on the general health of patients who underwent such procedures at an older age. The present study aimed to evaluate depression and anxiety symptoms, risky alcohol consumption, and binge eating in older adults undergoing bariatric surgery. METHODS: This study used current data (from medical records and tests) to conduct a cross-sectional study. A total of 74 individuals aged 60 years and older who underwent bariatric surgery after 55 years of age at a specialist center for obesity management located in Brazil were included and evaluated by the Beck Depression Inventory, Beck Anxiety Inventory, Alcohol Use Disorders Identification Test, and Binge Eating Scale. Demographic and clinical data related to the surgical procedure (weight loss) were also collected. The Cochran-Armitage trend test, Pearson’s χ2 test, and a multiple linear regression model were used as needed. A p < 0.05 was considered significant. RESULTS: The individuals were white (65.70%) and women (78.30%), with a mean age of 65.8 (SD 3.90) years. The mean time elapsed from surgery to evaluation was 75.70 (SD 43.70) months; 10.80% of the participants had moderate to severe depression, 8.10% moderate to severe anxiety, and 5.40% risky or high-risk alcohol consumption. None of the participants had binge eating problems. Weight regain was not associated with depressive symptom severity or risky alcohol consumption, but it was significantly associated (p = 0.034) with few or neither anxiety symptoms. Excess weight loss was not associated with any study variable. CONCLUSION: The results show a low prevalence of mental symptoms in older adults undergoing bariatric surgery compared to data from the literature on younger adults undergoing the same procedure.

Review of the management of diarrhea syndrome after a bariatric surgery

Obesity is a prevalent health problem in our population. Bariatric surgery is the indicated treatment for severe cases. It is very effective (together with an adequate lifestyle modification) but it is also associated with frequent adverse events. One of the most frequent and disturbing adverse event is diarrhea. Diarrhea after bariatric surgery may be secondary to multiple causes and the physiopathogenic mechanisms may depend on the type of surgery performed. The most frequent diarrhea mechanisms are dumping syndrome, vagotomy, short bowel syndrome, carbohydrate malabsorption, protein malabsorption, alterations of the microbiota, Clostridium difficile infection, bacterial overgrowth, bile salt malabsorption, pancreatic insufficiency, endocrinological disorders, addictive disorders, and other digestive disorders not necessarily related to surgery.

Bulimia nervosa in obese patients qualified for bariatric surgery - clinical picture, background and treatment

Eating is a basic human physiological need which is necessary to keep the body alive. Eating disorders are diagnosed when eating (or not eating) and associated body weight gain anxiety become the main interest of an individual and all other spheres of life depend on it. Bulimia nervosa is a psychiatric disorder which is more and more commonly diagnosed in patients suffering from obesity and in patients after surgical treatment of obesity. In patients eligible for bariatric surgery this disorder should be diagnosed appropriately early and treated successfully before the procedure, because bulimia nervosa does not regress spontaneously. When untreated, it may last for years, reducing the efficacy of a surgical treatment of obesity, or even lead to complications that are health- and life-threatening for patients.

Pregnancy, delivery, and breastfeeding after total gastrectomy for gastric cancer: a case report

Background

The reports of pregnancy after total gastrectomy for gastric cancer are rare.

Case presentation

We report a case of a 35-year-old woman, gravida 0, para 0, who became pregnant and delivered a baby 2 years and 6 months after laparoscopic-assisted total gastrectomy for early gastric cancer. Postoperatively, she showed a good progress during the follow-up and was continuously taking oral iron supplement and administered with methylcobalamin intramuscular injection. Two years after gastrectomy, she became pregnant. During the pregnancy, she kept taking iron and vitamin B₁₂ supplementation and had a good course of pregnancy and a normal delivery. However, 2 months after the delivery, liver dysfunction was detected via blood examination. The patient switched from exclusive breastfeeding to combined feeding with formula, and her laboratory results returned to normal. During 10 years of follow-up after the delivery, the patient was in good condition without any recurrence and nutritional deficiencies, and her child had thrived.

Conclusions

Careful monitoring and management of iron and vitamin deficiencies are essential during pregnancy and the lactation periods for patients who previously underwent total gastrectomy. During the lactation period, a combination of formula and breastfeeding provides maternal and fetal nutritional support.

Transient severe distributive shock due to early dumping syndrome: a case report

Background

Early dumping syndrome characterized by palpitation, dizziness, cold sweat, feebleness, and abdominal symptoms, occurs within 30 minutes after meals in patients who have undergone gastrectomy. This case report describes the case of a patient who presented with severe distributive shock due to early dumping syndrome; he recovered within a few hours after massive fluid infusion and vasopressor administration.

Case presentation

Our patient was a 68-year-old Japanese man who underwent total gastrectomy for gastric cancer and was diagnosed as having late dumping syndrome. On admission, he developed severe shock and was treated with massive fluid administration. Based on the history of the present illness, past medical history, normal findings of blood chemistry test, transient course, and Sigtad score, which helps diagnose dumping syndrome, early dumping syndrome was considered the cause of severe distributive shock.

Conclusions

Early dumping syndrome can cause severe shock requiring massive fluid infusion and vasopressor administration. It should be considered a cause of severe distributive shock in patients who have undergone gastrectomy.